Edith Cowan University Edith Cowan University Research Online Research Online Theses : Honours Theses 1990 Nurses' use of universal precautions Nurses' use of universal precautions Robin G.S. Jackson Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses_hons Part of the Nursing Administration Commons Recommended Citation Recommended Citation Jackson, R. G. (1990). Nurses' use of universal precautions. https://ro.ecu.edu.au/theses_hons/200 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses_hons/200
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Edith Cowan University Edith Cowan University
Research Online Research Online
Theses : Honours Theses
1990
Nurses' use of universal precautions Nurses' use of universal precautions
Robin G.S. Jackson Edith Cowan University
Follow this and additional works at: https://ro.ecu.edu.au/theses_hons
Part of the Nursing Administration Commons
Recommended Citation Recommended Citation Jackson, R. G. (1990). Nurses' use of universal precautions. https://ro.ecu.edu.au/theses_hons/200
This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses_hons/200
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USE OF THESIS
The Use of Thesis statement is not included in this version of the thesis.
NURSES' USE OF UNIVERSAL PRECAUTIONS
BY
ROBIN G.S. JACKSON R.N.
A Thesis Submitted in Partial Fulfilment of the
Requirements for the Award of
Bachelor of Health Science (Nursing) Honours
at the School of Nursing, Western Australian
College of Advanced Education.
Date of Submission : 21st May 1990
11 JUL 1991
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TABLE OF CONTENTS
ABSTRACT
DECLARATION
ACKNOWLEDGEMENTS
LIST OF TABLES
INTRODUCTION
Background and Purpose.
Problem Statement and Question for Study.
Definitions.
Specific Study Objectives.
REVIEW OF LITERATURE
The Impact of AIDS on Cross Infection Policy.
Concern of Society and Age Groups Involved.
Universal Precautions Versus Body Substance
Isolation Technique.
Relevant Studies.
METHODS
Population and Sample
Design and Instrument
Data Collection
RESULTS
DISCUSSION
Recommendations
REFERENCES
APPENDIXES
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5
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11
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26
37
45
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ABSTRACT
Research into Acquired Immune Deficiency Syndrome, Hepatitis B., and other
bloodborne pathogens has led to the current worldwide awareness that patients can
be admitted to hospitals with potentially fatal diseases that can remain undetected in
blood and certain body fluids. This has resulted in a change of emphasis in
Infection Control, namely isolating the source of infection rather than isolating the
diagnosed infectious patient. One such technique recommended to protect health
care workers, and other patients from nosocomial disease, is Universal Precautions.
This study, using a descriptive survey design and structured questionnaire examined
nurses' stated compliance to this technique in a suburban, non-teaching hospital of
over 100 beds. The 77 subjects, who volunteered to complete a questionnaire, were
all currently involved in direct patient care. Nursing staff working in the General
Geriatric Ward, Psycho-Geriatric Ward, General Surgical/Medical Ward, Maternity
Ward, and Operating Rooms were invited to take part in the study. The data
collection took place over a one week period by the investigator personally taking
the questionnaires to the wards. The analysis of the data, using a Statistical
Analysis System, showed that even though the level of knowledge and opinion level
were positive, the stated practice of Universal Precautions was low. The range of
correlations was so small that the planned multiple regression was only carried out
for one variable, knowledge, the result of which was F(l,75)=1.38, E<.24., which
was not significant. The results of one-way analysis of variance computed for
stated practice by experience, level designation, and area of work were not
3
significant. This study revealed that though nurses may have a reasonable level of
knowledge, and a positive opinion towards Universal Precautions, the Stated
Practice may be low regardless of the years of experience, level of employment or
area of work. Research needs to be continued to further examine what other factors
may be influencing the lack of stated compliance by nurses' to Universal
Precautions, a recommended technique of nosocomial disease protection.
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DECLARATION
"I certify that this thesis does not incorporate, without acknowledgement, any
material previously submitted for a degree or diploma in any institution of higher
education and that, to the best of my knowledge and belief, it does not contain any
material previously published or written by another person except where due
reference is made in the text".
SIGNATURE:
5
ACKNOWLEDGEMENTS
Ruth C. MacKay, M.N., PhD., who as my supervisor gave valuable guidance and
support throughout the research project from proposal to completed thesis.
Amanda M. Blackmore BSc Hons who gave assistance with techniques of data
analysis and running of computerised statistic packages.
The Registered Nursing staff of Western Australian College of Advanced Education
who completed questionnaires and gave informative feed-back.
The three Clinical Nurse Specialists who took time to assess the content validity of
the questionnaire.
The Research Nurse at the hospital participating in the study for her support of the
research project. All the nursing staff of the hospital involved, who by volunteering
to fill in a questionnaire, made the data collection possible.
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LIST OF TABLES
Tables �
1. Type of Nurse by Assumed Risk of Exposure. 27
2. Length of Clinical Experience by Assumed Risk of Exposure. 28
3. Mean, Standard Deviation, Range, and Scale Limits 29
Pertaining to Nurses' Stated Practice, Opinion,
and Knowledge.
4. Mean, Standard Deviation, and Range of Stated Practice Scores 30
by Nurse Level, Area, and Experience.
5. Mean, Standard Deviation, and Range of Opinion Scores by 31
Nurse Level, Area, and Experience.
6. Mean, Standard Deviation, and Range of Knowledge Scores 32
by Nurse Level, Area, and Experience.
7. Correlation Matrix of Stated Practice, Opinion, and Knowledge. 33
8. Significance of Variance in Stated Practice Accounted 34
for by Knowledge.
9. One-way Analysis of Variance of Stated Practice by Area. 35
10. One-way Analysis of Variance of Stated Practice by 35
Nurse Level.
11. One-way Analysis of Variance of Stated .Practice by Experience. 36
7
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INTRODUCTION
Background and Purpose
During the last decade there has been a worldwide increase of incidence of
bloodbome viral infections. The presence of Acquired Immune Deficiency
Syndrome (AIDS), Hepatitis B., and other bloodbome pathogens is now recognised
in most communities. Research into such infections has led to the current
awareness that patients may be admitted to hospitals with a potentially fatal disease
that can remain undetected in blood and certain body fluids.
The condition commonly referred to as AIDS was first identified in the United
States in 1981. Since then cases have been reported in all parts of the world. With
further study, AIDS was found to be caused by a virus, Human Immunodeficiency
Virus (HIV), that can remain undetected in blood and certain body fluids. This
disease, combined with Hepatitis B and other bloodbome pathogens in health care
settings, has caused a change in cross infection policy throughout the world. One
impact has been on health care workers and methods to prevent nosocomial
(hospital acquired) disease. The result has been the development of Universal
Precautions or Universal Blood and Body Fluid Precautions and Body Substance
Isolation.
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The policy change in cross infection has resulted in a shift of emphasis in cross
infection control, which is to isolate the source of the infection rather than relying
on a diagnosis and isolating the infectious patient. The potential source of infection
in bloodbome infections is blood and certain body fluids. To isolate these
substances in all patients is known as Universal Precautions.
The situation exists that patients with undiagnosed, potentially fatal infections can
be admitted to hospital creating a health hazard to health care workers and other
patients. The purpose of this study is to examine to what degree nurses follow
recommended techniques of preventing cross infection.
Problem Statement and Question for Study
The incidence of bloodbome infections, particularly AIDS, is increasing in the
community. The World Health Organisation predicts that by the end of the 1990s
the number of AIDS cases will rise to six million (Nornhold, 1990). Though most
new cases will be in the Third World countries, other countries will correspondingly
experience an increase of AIDS cases. It therefore follows that the percentage of
patients admitted to hospital with undiagnosed potentially fatal diseases will also
increase. Logically the risk factor to health care providers must increase with the
increasing incidence within the community. Though the risk to health care workers
is considered to be small it does exist as a personal health hazard. In Sydney three
doctors and three nurses have been placed on a course of the antiviral drug AZT
following "significant exposure" to HIV positive body substances from infected
9
patients while at work. The Royal Prince Alfred Hospital in Sydney has recently
introduced a policy of offering prophylactic AZT to all staff who have experienced
"significant exposure" to HIV within 72 hours of exposure. AZT is a very
expensive drug, a six week course costs $1043, and though its effect on slowing
down, and perhaps preventing Aids is shown in animal experiments, there is no
conclusion about its effectiveness in human beings (Hicks, 1990). The risk exists,
and the fact that a hospital has offered AZT to its staff, in this manner,
demonstrates the level of concern by authorities in one hospital in Australia.
Most hospitals provide Hepatitis B vaccination for nurses as part of the staff
protection polices, but to date there is no vaccine available for protection against
other bloodbome pathogens such as AIDS. The lack of proof of the effectiveness,
and the expense involved, rules out the possibility of using AZT as a prophylactic
drug to protect health care workers from AIDS.
Nurses are at times exposed to patients' blood and body fluids and it is not
practical, nor is it possible to screen all patients for bloodbome infections prior to
admission to hospital. Though some health care workers are of the opinion that it is
essential for hospital staff to know the HIV status of the patient, for reasons of
ethics, protection of people's privacy, and . to prevent discrimination, mandatory
screening of patients is not recommended by AIDS policy advisors (AIDS
prevention and control, 1988). In regard to accident and emergency admissions it is
not possible to ascertain the HIV status of the patient prior to admission. At present
10
the tests that are available to establish HIV status can, for various reasons, give a
false positive or false negative result.
The only remaining means of protecting hospital staff against potentially fatal
diseases is the use of recommended cross infection polices, to isolate the source of
infection. It is therefore important to examine to what degree nurses follow the
recommended cross infection policy change of isolating blood and certain body
fluids of all patients.
As part of the worldwide movement to promote safety amongst health professionals,
the hospital participating in the study, over a year ago, introduced Universal
Precautions. This study was undertaken to ascertain the stated compliance of
nurses, involved in direct patient contact in most areas of the hospital, to the
principles of Universal Precautions.
Specifically the following research question was posed: What is the level of nurses'
stated practice to Universal Precaution principles?
Definitions
The terms Universal Precautions and Body Substance Isolation are often used
interchangeably which can be confusing. Under Universal Precautions, blood and
certain body fluids of all patients are considered potentially infectious. Body
Substance Isolation considers all moist body substances of all patients as potentially
11
infectious.
The Centres for Disease Control (C.D.C.), Atlanta, Georgia made the following
recommendations for Universal Precautions (Cook 1988):-
Body Fluids to Which Universal Precautions Apply
blood
semen
vaginal secretions
tissues
cerebrospinal fluid
synovial fluid
pleural fluid
peritoneal fluid
pericardial fluid
amniotic fluid, and
other body fluids containing visible blood
Body Fluids to Which Universal Precautions Do Not Apply
faeces
nasal secretions
sputum
sweat
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tears
urine
vomitus
The concept of Body Substance Isolation can be described as:
Body Substance Isolation
body fluids
body tissues
excreta
Hospitals have developed their cross infection policies between Universal
Precautions, as recommended by the C.D.C., and the total coverage of Body
Substance Isolation.
For the purpose of this study, Universal Precautions shall be defined as described
by the hospital involved in the study. That is, to add faeces and urine to the CDC
list of body fluids to which Universal Precautions apply.
Body Fluids to Which Universal Precautions Apply:
blood
faeces
urine
vaginal secretions
semen
13
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body tissue
cerebrospinal fluid
synovial fluid
pleural fluid
peritoneal fluid
pericardial fluid
amniotic fluids
other body fluids containing blood
The major variables studied were knowledge of Universal Precautions, opinion of
cross infection principles, hospital area of work, length of experience, level
designation, and stated practice.
Definitions of Major Variables
Independent: 1. Knowledge what nurses know about Universal
Precautions based on the Hospital's policy on infection
control.
2. Opinion - what nurses believe/think about cross infection
principles.
3. Area of work - high, moderate, and low risk area
according to the assumed exposure risk level of the unit
the nurse is working in currently.
4. Experience - how long the nurse has been involved in
direct patient care.
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Dependent:
5. Level designation - current level of employment category
of position held.
Stated practice - the nurse's stated action in carrying out
Universal Precautions.
Specific Study Objectives
The specific study objectives were to determine:-
1. If practice as stated by nurses reflects Universal Precaution principles;
2. The effects of knowledge on stated practice;
3. The effect of opinion on stated practice;
4. The effect of the area of work on stated practice;
5. The effect of experience on stated practice.
6. The effect of level designation on stated practice.
REVIEW OF LITERATURE
The Impact of AIDS on Cross Infection Policy
Since the identification of AIDS, various means of communication have been used
to distribute information about the disease. Included in this have been books
written on all aspects of the condition. Often included in the books is a section on
the history and spread of AIDS. One editor covers this under the heading
'Development of the Epidemic' (Alder 1988), which is how most authors view the
15
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AIDS phenomenon. In fact some have likened it to a 20th century outbreak of the
"black plague".
A point made by Brass and Gold (1985) is that despite the discovery of the
causative virus little else is really known about AIDS as a disease process,
including detailed knowledge on aspects of the transmission from one person to
another. There is now no known cure, and discussion in the literature includes
means of self protection against the infection such as safe sex practices and once
only use of sterile needles by intravenous drug users (Adler, 1988; Brass and Gold,
1985; Connor and Kingman, 1988). In regard to transmission of the disease to
health care workers, or other patients, little is written in books. Connor and
Kingman (1988) say "Health-care workers do, of course, have to take special care
when handling blood which may be infectious" (p. 13). Brass and Gold (1985)
make the point that "The evidence on health workers catching the virus is still very
contradictory" (p. 144), but later state "To be as secure as possible, any health
workers who have contact in their work with members of the general public should
take extra care not to expose themselves to potentially virus-carrying body fluids"
(p. 145).
So in the literature on AIDS, where is the evidence that it was indeed the advent of
the AIDS epidemic that led to the development of Universal Precautions as a
recommended method of protecting health care workers? This development 1s so
recent that at present written evidence is found only in Government Policy
16
Publications and Journal Articles.
The impact that identification of AIDS, and the discovery of its causative virus,
HIV, have had on isolation nursing and cross infection techniques, can best be seen
in the following quote from Morbidity and Mortality Weekly Report (1988):
"In 1983, CDC published a document entitled 'Guideline for Isolation Precautions in Hospitals' ... The recommendations in this section called for blood and body fluid precautions when a patient was known or suspected to be infected with bloodborne pathogens. In August 1987, CDC published a document entitled 'Recommendations for Prevention of HIV Transmission in Health-Care Settings'. In contrast to the 1983 document, the 1987 document recommended that blood and body fluids precautions be consistently used for all patients regardless of their bloodborne infection status. This extension of blood and body fluid precautions to ALL patients is referred to as 'Universal Blood and Body Fluid Precautions' or 'Universal Precautions'. Under Universal Precautions, blood and certain body fluids of all patients are considered potentially infectious for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and other bloodborne pathogens." (p. 36)
Up until this time only known infectious patients had been nursed with special
precautions such as isolation nursing. It is now recognised that it is the unknown
infection the patient may have that is the potential hazard. What infection control
experts are now saying is that all patients should be viewed as potentially
infectious.
Concern of Society and Age Groups Involved
A measure of concern by society about this condition can be judged by the fact that
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most western governments have published updated information and policies in
regard to all aspects of AIDS. In Australia such papers support the CDC Universal
Precautions as a means of infection control. Aids: A Time to Care, A Time to Act
(1988), National HIV/AIDS Strategy (1989).
A high exposure to blood and body fluids not only occurs for health care workers in
Operating Rooms and Accident and Emergency Departments, but also in Delivery
Suites and Maternity units. Heterosexual spread of AIDS to women is increasing,
and most women who are infected are of child bearing age. Fekety (1989), a
midwife, states: "As the epidemic expands worldwide, greater proportions of our
clients will be at risk, and the heterosexually infected women and perinatally
infected baby will be encounted with increasing frequency until the spread of the
disease can be curtailed" (p. 257). According to Zeidenstein (1989), the reality of
AIDS is also causing a return to midwives using gowns, glasses, masks and gloves,
a practice that many discarded in the 1960s - '1970s.
At the other end of the age scale, health care workers involved in gerontological
nursing are beginning to become aware that older adults may be HIV positive, and
be infected with AIDS. At present little is known about AIDS infection in the
elderly. The CDC weekly surveillance reports group all people over the age of 49
together, so there is no way of knowing the incidence of AIDS in people over 65
(Whipple, 1989).
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Not all people who are HIV positive present with the signs and symptoms of AIDS.
People who are HN positive have an increased incidence of neurological
abnormalities and it is possible that people who are diagnosed as having dementia,
organic brain syndrome, or Alzheimer's disease may be HN infected (Mirra,
Anand, and Spira, cited in Whipple, 1989).
It is becoming increasingly apparent that health care workers have need for some
form of self protection when providing care for others, regardless of the age of the
patient.
Universal Precautions Versus Body Substance Isolation Techniques
The concept of Body Substance Isolation was proposed by Lynch, Jackson,
Cummings, and Stamm (1987). This consisted of the use of barrier precautions
(gloves, plastic aprons etc) when health care workers are exposed to the patient's
moist body substances, mucous membranes, and nonintact skin. Hollik (1989) in
comparing this to Universal Precautions says this method "emphasizes protection of
patient to patient cross infection in addition to protection of the employee", but
further states:- "Strict adherence to Body Substance Isolation, in many respects
represents an overkill approach to Infection Control" (p 77).
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Relevant Studies
One criticism of both Universal Precautions and Body Substance Isolation
techniques has been that in an emergency situation, staff don't have time to put on
protective gloves and aprons. Kelen, Di Giovanna, Bisson, Kalainov, Sivertson, and
Quinn (1989) in a study involving an emergency department, found health providers
followed Universal Precautions during 44% of interventions. In patients with
profuse bleedings, adherence fell to 19.5% The most common reasons given by
providers for not following precautions were insufficient time to put on protective
attire and interference with procedural skills.
Another study done by Baroff and Talan (19S9), also in an emergency department,
concluded that there is currently a low rate of compliance with Universal
Precautions polices by emergency department personnel.
Another comment has been made that some staff go from patient to patient using
the same pair of gloves (Valenti, 1988). For the present though it remains a fact
that health-care workers and other patients require protection from nosocomial
disease and the use of Universal Precautions or Body Substance Isolation is the
most effective way to date.
The literature reviewed establishes that bloodbome infections are a worldwide
problem, and the AIDS epidemic is in progress. Regardless of the age of the
patient or area of work health care workers need to be aware of the resulting
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changes in cross infection policy and need to take care in protecting themselves by
implementing recommended methods of Universal Precautions. The development
and rationale for the use of Universal Precautions is well supported, but evidence of
the actual use of Universal Precautions is lacking, other than the low standard of
use in emergency departments.
METHODS
Population and Sample
The population for the pilot study was Registered Nurses currently employed by the
School of Nursing at the Western Australian College of Advanced Education. The
10 who volunteered to take part in the pilot study were all currently involved in
clinical practice in similar areas as the areas used in the study.
The population was the nursing staff employed at a suburban, non-teaching hospital
of over 100 beds in Perth, Western Australia. All nursing staff working at the time
of the data collection were invited to take part. The study sample consisted of
nurses from the General Geriatric Ward, Psycho Geriatric Ward, General
Surgical/Medical Ward, Maternity Ward and Operating Rooms.
All full-time and permanent part-time nurses involved in direct 'hands-on' delivery
of care, and not on leave, were invited to take part in the study. This included all
Registered Nurses from level one, all Clinical Nurses from levels two and three, and
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all Enrolled Nurses. Agency and casual part-time staff were not included.
Design and Instrumentation
A descriptive survey design was used in this study, and data were collected by
means of a structured questionnaire.
The questionnaire (Appendix A) was used in this study as a means to measure three
of the variables, stated practice, opinion about cross infection principles and
knowledge about Universal Precautions. The data for the remaining three variables,
area of work, experience and level designation were obtained from the demographic
data form (Appendix B).
A search of the Medline data base, forward from 1984, and books which list
instruments used in nursing research, failed to find a suitable tool for data
collection. The only tool was mentioned in an abstract of a conference report. This
was subsequently obtained from Docken, one of the authors.
The instrument designed by Docken, Beiningen, and Vander Woude (1989) was
developed to monitor compliance with Body Substance Isolation, following its
implementation in a 499-bed acute care hospital. The instrument they used covered
three sections, practices, opinion, and knowledge. They determined it was better to
ascertain the compliance of their personnel based not only on stated practices, but
also on opinion and knowledge of the Body Substance Isolation policy. They further
stated that observational monitoring is difficult, in that individual judgement and
22
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skills in this area cannot be evaluated by simply observing. Also practices may be
skewed, they stated, because of the presence of observers. The instrument used in
this study was drawn from the instrument they used.
The concept of using the three sections, stated practice, opinion, and knowledge,
was retained. The format of stated practice was changed to a scenario with a choice
of stated action. Opinion was changed to a bi-polar graphic scale. Multi-choice
knowledge questions were checked against the literature about Universal
Precautions as defined by the hospital used in the study. Adjustments were then
made according! y .
To establish the level of content validity, a validity assessment by three content
specialists was carried out as described by Waltz, Strickland, and Lenz (1983, p.
196). They state an index of + 1.00 will occur when perfect positive item-objective
congruence exists, that is, when content specialists assign a + 1 to the item for its
relevance to the stated objective, and a -1 to those items which do not fit the
objective.
Three content specialists rated items on the objective set. The items tested were all
the questions from the stated practice and knowledge sections of the questionnaire .
All stated practice questions, except number -seven, had an index of item-objective
congruence of + 1.00. One content specialist disqualified herself from rating
question seven concerning a specialised area of practice outside of her experience .
The remaining two content specialists gave question seven an index of item-
23
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objective congruence of + 1.00. All knowledge questions had an index of item
objective congruence of + 1.00. The content of the questionnaire was therefore
accepted as valid.
To trial the questionnaire a pilot study was carried out to determine the clarity of
the questions, effectiveness of instructions, completeness of response sets, and the
time required to complete the questionnaire. Comments made by participants in the
pilot study resulted in the addition of a hand washing choice in the stated practice
section, and in the knowledge section the change of wording in one multiple choice
question, and the changing of an answer in one multiple choice response. These
minor adjustments were made to the questionnaire before the data collection
commenced.
Data Collection
The data collection took place over a one-week period. The investigator personally
took the questionnaires to the areas.
To protect human rights the investigator gave the subjects verbal information and a
written explanation was attached to each questionnaire (Appendix C). Subjects
were informed that to protect their identity no names would be recorded, and no
record was kept of the day, the time, or the group from which the questionnaires
came. Consent was assumed by subjects volunteering to return a questionnaire, and
the subjects were informed that they would not be discriminated against for not
24
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being involved, and that they could withdraw from the study at any time.
Also the subjects were informed of the purpose and use of the collected data, and
that the results of the study would be presented to the hospital and participants after
completion of the study.
Slit top boxes were provided for subjects to place the completed questionnaires in,
and the investigator collected the boxes each day.
On the first day the two Geriatric Wards were visited at handover time when both
the day and evening staff were present. The same format was used the second day
for the Maternity and General Medical and Surgical Wards. The areas were visited
in the same way every second day during the week, three times in all. The staff
from the Operating Rooms were invited to take part on one day only and all staff
not on leave were present that day. On two alternative nights the nightstaff in all
four wards were invited to participate. Of the _ 100 questionnaires distributed 77 were
completed and returned. This represented a 77% return.
Methodological limitations occur in using a questionnaire to assess stated
compliance. With the use of a questionnaire the problem exists in assuming
practice on the basis of stated behaviours, and it is assumed that participants
honestly state their practice. To assess compliance direct observations are often
used, but due to time restraints and complexities involved in using observations this
25
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was not possible in this study. To help establish the level of instrument reliability it
was intended to use Cronbach's coefficient alpha to test for homogeneity of internal
consistency for each of the scales in the instrument. Unfortunately the programme
was not available to be used. It is recommended that this be done prior to the
instrument being used in future studies.
It was not possible to assess concurrent validity because no other instrument was
available for comparison.
RESULTS
At completion of the data collection the data were coded prior to analysis using the
Statistical Analysis System (SAS). The level of significance was set at .05 for
hypotheses testing.
The level designation of the subjects was divided into three levels.
Level A
Level B
Level C
Enrolled Nurses
Registered Nurses currently employed as a Level 1
Registered Nurses currently employed as a Level 2 or 3.
The area of work was divided into three categories according to the assumed risk
level of nurses being exposed to splashing, or spraying, with patients' blood or body
fluids.
26
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Area 1
Area 2
Area 3
high risk - operating rooms and maternity ward (included
delivery suite).
moderate risk - general surgical and medical wards.
low risk - general geriatric and psycho geriatric wards.
Details of the sample numbers in each area of assumed risk and type of nurse are
displayed in Table 1. The sample details of the area of assumed risk and
role of isolation practices in the prevention of nosocomial infections. Annals of
Internal Medicine, 1.01, 243-246.
Morbidity and Mortality Weekly Report. (1988). Update: Universal precautions for
prevention of transmission of human immunodeficiency virus. hepatitis B virus,
and other bloodborne pathogens in health-care settings, TI, 377-389.
National HIV/AIDS strategy, (1989). Canberra: Australian Government Publishing
Service.
Normhold, P. (1990). 90 predictions for the 90s. Nursing 90 2!l (1), 34-41 .
Valenti, W.M. (1988). From ritual to reason and back again: OSHA and the evolution
of infection control, Infection Control Hospital Epidemiology, .2, 289-290.
Waltz, C.F., Strickland, O.L., & Lenz, E.R. (1984). Measurement in nursing research
Philadelphia: F.A. Davis Company.
Whipple, B., & Scura, K.W. (1989). HIV and the older adult taking the necessary
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Zeidenstein, L. (1989). Adapting universal precautions in a CNM service. Journal of
Nurse Midwifery, JA., 280-283.
47
APPENDIX A
QUESTIONNAIRE
Protection of Nursing Staff Survey
Imagine yourself in the following real life scenes.
What would you do in each situation in order to protect yourself in a cost effective manner.
1 . An elderly man with Parkinsons disease and dementia, after using a urinal spills the urine in his bed. You go to change the bed linen.
What action do you take BEFORE you attend to the patient.
Circle your answer or answers.
A. No action or The following can be more than one action.
B. Put on goggles C. Put on gloves D. First wash hands E. Put on a plastic apron F. Put on a mask
2. A middle aged woman is admitted with a history of a gastric ulcer and vomitmg coffee ground coloured fluid. You answer her call bell and find her vomiting frank blood. You go to her assistance.
What action do you take BEFORE you attend to the patient.
Circle your answer or answers.
A. No action or The following can be more than one action.
B. Put on goggles C. Put on gloves D. First wash hands E. Put on a plastic apron F. Put on a mask
3. A young woman with a crushed right hand is admitted to hospital. She continues to breast feed her three week old baby, who has been admitted with her. She requests your assistance to express some milk.
What action do you take, BEFORE you attend to the patient.
Circle your answer or answers.
A. No action or Toe following can be more than one action
B. Put on goggles C. Put on gloves D . First wash your hands E. Put on a plastic apron F. Put on a mask
4. A young male recovering from a head injury requires feeding at meal times. His past medical history includes a positive HIV blood test. He is quiet and cooperative and you go to feed him at lunch time.
What action do you take BEFORE you attend to the patient .
Circle your answer or answers.
A. No action or Toe following can be more than one action
B. Put on goggles C. Put on gloves D. First wash your hands E. Put on a plastic apron F. Put on a mask
5. A middle aged woman, one day post operation following a chokcystectomy has developed a productive cough. She requires a lot of assistance and encouragement to deep breath and cough. To obtain a sputum specimen you are going to assist her to cough.
What action do you take BEFORE you attend to the patient.
Circle your answer or answers.
A. No action or The following can be more than one action.
B. Put on goggles C. Put on gloves D . First wash your hands E. Put on a plastic apron F. Put on a mask
6. An elderly man recovering from a haemorrhoidectomy has j ust gone back to bed after having his bowels opened. He calls you over and says he thinks he has had a further bowel action in the bed. You ensure privacy and pull back the bed linen and see a large pool of blood and faeces.
What action do you take BEFORE you attend to the patient.
Circle your answer or answers.
A. No action or The following can be more than one action.
B. Put on goggles C. Put on gloves D. First wash your hands E. Put on a plastic apron F. Put on a mask
7. The maternity unit is very busy and you have been asked to give a nl.!w bum baby its first bath. The motht:r is well but sedated. The baby is physically normal and in nu Jistrl.!ss.
What action do you take BEFORE you attend to the baby .
Circle your answer or answers.
A. No action or The following can be more than one action.
B. Put on goggles C. Put on gloves D . First wash your hands E. Put on a plastic apron F. Put on a mask
J..
WHAT IS YOUR OPINION OF THE FOLLOWING STATEMENTS: RATE THEM ON A SCALE OF 1 TO 6 CIRCLE THE APPROPRIATE NUMBER
STATEMENT
1 . Nursing, when compared to other occupations, has a low level of health hazard in the work place
Strongly Agree 1 2 3 4 5 6 Strongly Disagree 2. Nurses are best protected by
knowing the patients' diagnosis of any infectious disease.
Strongly Agree 1 2 3 4 5 6 Strongly Disagree 3. Using gloves means you don' t
have to wash your hands as often. Strongly Agree 1 2 3 4 5 6 Strongly Disagree
4. It would be cost effective. and create no risk. if the nurse wore the same pair of gloves for several patients as needed.
Strongly Agree 1 2 3 4 5 6 Strongly Disagree 5. Wearing gloves makes it awkward
and difficult to carry out procedures.
Strongly Agree 1 2 3 4 5 6 Strongly Disagree 6. A nurse's best protection from
infection is an intact skin. Strongly Agree 1 2 3 4 5 6 Strongly Disagree
7. It is easy to put on gloves. plastic apron. and goggles as recommended.
Strongly Agree I 2 3 4 5 6 Strongly Disagree 8. In providing health care for
masks and plastic aprons available in every patients room is a waste of money.
Strongly Agree 1 2 3 4 5 6 Strongly Disagree 10. The best protection from cross
infection is hand washing after patient contact.
Strongly Agree 1 2 3 4 5 6 Strongly Disagree
CIRCLE THE APPROPRIATE ANSWER: (one answer only)
1 . Plastic gloves should be worn:
-·
a. when handling blood. tissue and body fluids of all patients. b. when both your hands are affected by dermatitis. c. when handling blood. tissue and body fluids of a patient with a diagnosed infection. d. all of the above.
Plastic aprons should be worn:
a. When you need to wear your uniform twice before it is washed. b. When you may be splashed with body fluids. c . When you have a cut on your abdomen. d. All of the above.
3 . Goggles and masks should be worn:
a. b. C. d.
When vou have an infected eve. • ,I
When you may be sprayed with body fluids. When you do a mouth toilt:t. All of the above .
4. Which of the following constitutes a "significant exposure" :
a. Blood splash to mouth, nose, eyes, or an open skin lesion. b. Needlestick with a sterile needle. c. Mouth-to-mouth resuscitation. d. All of the above.
5 . Patients with infections that spread through only blood or body fluids:
a. Will always have the diagnosis written in the notes. b. Will be adequately isolated if routine procedures of blood and body fluids precautions
are carried out. c. Will most often have obvious symptoms and be identifiable by clinical assessment. d. All of the above.
6. Overwearing of gloves when not indicated may result in:
a. Increased contamination of the environment. b. Increased risk of cross-infection to patients. c. Increased risk to employee hand irritation/dermatitis. d. All of the above.
7. Hand washing is now considered:
a. To be replaced by using gloves when handling blood and body fluids. b. To be the most important means of preventing cross infection. c. Not necessary if gloves have been worn. d. None of the above.
8 . To maintain your skin protection you should:
a. Frequently use a moisturiser b. Cover cuts with a waterproof sealed dressing. c. Wear gloves if you have chaffed hands. d. All of the above.
9. Used needles should always:
a. Be recapped and placed in a waterproof bag prior to disposal. b. Be recapped, carried in a container, and disposed of in a sharps container. c. Not be recapped, carried in a container. and disposed of in a sharps contained. d. Not be recapped, carried in the hand. and disposed of in a sharps container.
10. Last night you cut yourself on the middle finger of your left hand. This morning the cut is drv. What should vou do when vou arrive at work:
J J J
a. Place a band-aid over the cut. b. Leave the cut exposed. c. Put on a plastic glove. u. Put a waterproof, sealed dressing over the cut.
APPENDIX B
DEMOGRAPHIC DATA
Please tick the appropriate answer: Category of employment designation:
